Trocar Support

ABSTRACT

A support apparatus for supporting a trocar while the trocar extends through a body wall of a patient includes an inflatable collar and a slidable abutment collar commonly connected for engagement onto the trocar following which the slide collar is released to slide along the trocar. The inflatable collar is inflated to a set size by a manually operable pump on the slidable collar operated by squeezing finger abutments together up to a latch so that threaded portion expels the inflation fluid. The abutment member is shaped to be received on an outer surface of the trocar and adjustable longitudinally of the trocar sleeve so as to be located at a selected position by a manually movable latch collar. The inflatable collar and slidably collar are held connected by a manually operable release.

This invention relates to an apparatus arranged to locate and hold atrocar in position through the wall of the body of the patient.

BACKGROUND OF THE INVENTION

In published PCT application 2013/023293 published Feb. 21 2013 of thepresent Applicant is shown a support apparatus for supporting a trocarwhile the trocar extends through a body wall of a patient includes aninflatable collar extending around the trocar which can be inflated to apredetermined size by a source of fluid where the source of fluid islocated on the trocar support apparatus itself so as to be carriedthereby and is defined by a pump mechanism to provide a fixed volumeallowing inflation only to a fixed size. An abutment member is shaped tobe received on an outer surface of the trocar sleeve and adjustablelongitudinally of the trocar sleeve so as to be located at a selectedposition. A tube connecting the pump on the abutment to the inflatablecollar is wrapped helically around the sleeve of the trocar.

SUMMARY OF THE INVENTION

It is one object of the invention to provide an improved trocar supportof this general type.

According to one aspect of the invention there is provided a trocarsupport apparatus for use with a trocar separate from the apparatus formaintaining the trocar in fixed position in a body wall of a patientwhile the trocar extends through the body wall of a patient, the supportcomprising:

an annular expandable member for extending around the trocar, saidannular expandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize;

an annular abutment collar arranged to be received on the trocar at arequired position thereon;

the annular abutment collar being adjustable longitudinally of thetrocar so as to be located at a selected position;

a releasable clamping member on the annular abutment collar for locatingthe annular abutment collar on the trocar at the selected position;

said annular expandable member being arranged while in said collapsedcondition to be inserted through an incision in the body wall andexpanded when inserted to engage an inside surface of the body wall;

wherein the annular expandable member is expandable by a manuallyoperable device providing a source of the fluid mounted on the annularabutment collar;

wherein the manually operable device comprises a pair of annular memberslocating a fluid containing member therebetween, the annular members andthe fluid containing member surrounding a central opening for passagetherethrough of the trocar;

and a manually operable compression device for squeezing one annularmember in an axial direction toward of the other annular member forexpelling fluid from the fluid containing member.

According to another aspect of the invention, which can be usedindependently or in combination with the above, there is provided atrocar support apparatus for use with a trocar separate from theapparatus for maintaining the trocar in fixed position in a body wall ofa patient while the trocar extends through the body wall of a patient,the support comprising:

an annular expandable member for extending around the trocar, saidannular expandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize;

an annular abutment collar arranged to be received on the trocar at arequired position thereon;

the annular abutment collar being adjustable longitudinally of thetrocar so as to be located at a selected position;

a releasable clamping member on the annular abutment collar for locatingthe annular abutment collar on the trocar at the selected position;

said annular expandable member being arranged while in said collapsedcondition to be inserted through an incision in the body wall andexpanded when inserted to engage an inside surface of the body wall;

wherein the annular expandable member comprises an elastomeric sleeveportion having an inner surface arranged to engage onto the trocar;

and wherein there is provided an insert sleeve portion on the annularabutment collar engageable into a hollow interior of the elastomericsleeve portion for engaging the inner surface and the holding the innersurface open for passage of the trocar.

According to another aspect of the invention, which can be usedindependently or in combination with any of the above, there is provideda trocar support apparatus for use with a trocar separate from theapparatus for maintaining the trocar in fixed position in a body wall ofa patient while the trocar extends through the body wall of a patient,the support comprising:

an annular expandable member for extending around the trocar, saidannular expandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize;

an annular abutment collar arranged to be received on the trocar at arequired position thereon;

the annular abutment collar being adjustable longitudinally of thetrocar so as to be located at a selected position;

a releasable clamping member on the annular abutment collar for locatingthe annular abutment collar on the trocar at the selected position;

said annular expandable member being arranged while in said collapsedcondition to be inserted through an incision in the body wall andexpanded when inserted to engage an inside surface of the body wall;

a connecting component mounted on the annular abutment collar forengaging a portion of the annular expandable member to engage and holdthe annular expandable member in engagement with the annular abutmentcollar for common insertion of the trocar therethrough to a requiredposition of the annular expandable member on the trocar;

and a release member operable to release the connecting component toeffect release of the annular expandable member from the annularabutment collar so that when released the annular abutment collar ismovable longitudinally relative to the annular expandable member suchthat the annular abutment collar is moved to a position to hold the bodywall between the annular abutment collar and the annular expandablemember.

According to another aspect of the invention, which can be usedindependently or in combination with any of the above, there is provideda trocar support apparatus for use with a trocar separate from theapparatus for maintaining the trocar in fixed position in a body wall ofa patient while the trocar extends through the body wall of a patient,the support comprising:

an annular expandable member for extending around the trocar, saidannular expandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize;

an annular abutment collar arranged to be received on the trocar at arequired position thereon;

the annular abutment collar being adjustable longitudinally of thetrocar so as to be located at a selected position;

a releasable clamping member on the annular abutment collar for locatingthe annular abutment collar on the trocar at the selected position;

said annular expandable member being arranged while in said collapsedcondition to be inserted through an incision in the body wall andexpanded when inserted to engage an inside surface of the body wall;

wherein the manually operable device comprises a pair of memberslocating an inflation fluid containing member therebetween;

and a manually operable compression device for squeezing one membertoward the other member for expelling the inflation fluid from the fluidcontaining member;

wherein the fluid containing member can be opened to enable the entry ofsterilizing fluid and closed to effect the expulsion of the inflationfluid.

In one optional arrangement the fluid containing member is opened by avalve.

In another optional arrangement the fluid containing member is movableto a position where a chamber defined therebetween is opened to allowthe entry of the sterilization fluid and then is closed to enclose avolume of the inflation fluid.

According to another aspect of the invention there is provided a trocarsupport apparatus for use with a trocar separate from the apparatus formaintaining the trocar in fixed position in a body wall of a patientwhile the trocar extends through the body wall of a patient, the supportcomprising:

an annular expandable member for extending around the trocar, saidannular expandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize;

an annular abutment collar arranged to be received on the trocar at arequired position thereon;

the annular abutment collar being adjustable longitudinally of thetrocar so as to be located at a selected position;

a releasable clamping member on the annular abutment collar for locatingthe annular abutment collar on the trocar at the selected position;

said annular expandable member being arranged while in said collapsedcondition to be inserted through an incision in the body wall andexpanded when inserted to engage an inside surface of the body wall;

wherein the manually operable device comprises a pair of memberslocating an inflation fluid containing member therebetween;

the members including a manually engageable projection extendinggenerally radially outwardly from the annular abutment collar;

and a manually operable compression device for rotating one memberaround the axis of the trocar toward of the other member for expellingthe inflation fluid from the fluid containing member.

The following defined optional features can be used independently of oneanother with any of the above independent aspects of the intentiondescribed herein.

In accordance with one important independent optional feature of theinvention, one of the annular members comprises a cylinder and the otherof the annular members comprises a piston defining a chamber in thecylinder so that the movement in the axial direction causes the chamberto be reduced in volume expelling the fluid therefrom.

In accordance with one important independent optional feature of theinvention, the cylinder and the piston can be moved to a positionallowing entry of a sterilizing fluid material from the exterior toenable the chamber to be properly sterilized.

In accordance with one important independent optional feature of theinvention, the manually operable compression device comprises a screwthread interconnecting the annular members so that rotation of onearound the axis causes said relative axial movement.

In accordance with one important independent optional feature of theinvention, the screw thread is on an outside surface of one of theannular members.

In accordance with one important independent optional feature of theinvention, the manually operable compression device includes a latch forholding the annular members in fixed position after a volume of fluid issupplied.

In accordance with one important independent optional feature of theinvention, the annular members are moved by squeezing together twoabutments projecting from an exterior of each of the annular memberswhere at least one of the abutments is rotatable around the axis.

In accordance with one important independent optional feature of theinvention, there is provided a latch extending between the abutments forholding the abutments in fixed position after the fluid is supplied.

In accordance with one important independent optional feature of theinvention, there is provided a spring which rotates the annular membersin a return direction to a retracted position to deflate the expandablemember.

In accordance with one important independent optional feature of theinvention, the spring is located between the annular members and iswound around the trocar.

In accordance with one important independent optional feature of theinvention, there is provided a connecting component mounted on theannular abutment collar for engaging a portion of the annular expandablemember to engage and hold the annular expandable member in engagementwith the annular abutment collar for common insertion of the trocartherethrough to a required position of the annular expandable member onthe trocar and a release member operable to release the connectingcomponent to effect release of the annular expandable member from theannular abutment collar so that when released the annular abutmentcollar is movable longitudinally relative to the annular expandablemember such that the annular abutment collar is moved to a position tohold the body wall between the annular abutment collar and the annularexpandable member.

In accordance with one important independent optional feature of theinvention, the surface of the connecting component surrounds the trocarso that a portion of the annular expandable member projects axially intothe interior of the surface.

In accordance with one important independent optional feature of theinvention, the connecting component comprises a ring on the annularexpandable member which is held by a sliding plate on the annularabutment collar with an opening in the plate to hold and release thering.

In accordance with one important independent optional feature of theinvention, the annular expandable member includes a sleeve slightlybigger than the trocar with an internal peripheral rib which engagesover a rib on the trocar to lock the annular expandable member in place.

In accordance with one important independent optional feature of theinvention, the annular expandable member is inflatable by a fluid.However other techniques for expansion of the expandable member can beused.

In accordance with one important independent optional feature of theinvention, the manually operable device is mounted on the annularabutment collar. Other mounting arrangements can however be used.

In accordance with one important independent optional feature of theinvention, the manually operable device comprises a pair of discs with afluid containing member such as a balloon, located therebetween, thediscs and the fluid containing member surrounding a central opening forpassage therethrough of the trocar.

In accordance with one important independent optional feature of theinvention, there is provided a manually operable compression device suchas a threaded member rotatable on the device for squeezing one of thediscs toward of the other discs for compression of the fluid containingmember.

In accordance with one important independent optional feature of theinvention, the coupling arrangement includes an insert sleeve portionengageable into a hollow interior of the elastomeric sleeve portion forengaging the inner surface and the holding the inner surface open forpassage of the trocar. Preferably the insert sleeve portion is taperedso as to hold the elastomeric sleeve portion in a frustoconical portionat the end edge of the elastomeric sleeve portion. This allows thetrocar to slide through sleeve portion and to be guided into the leadingedge of the elastomeric sleeve to reduce longitudinal forces on theelastomeric sleeve which could otherwise cause it to move longitudinallywith the trocar.

In accordance with one important independent optional feature of theinvention, the coupling arrangement includes a peripheral engagementmember for clamping a portion of the elastomeric sleeve portion againstthe insert sleeve portion. This acts to hold the elastomeric sleeveclamped in position with the annular abutment collar until it isreleased to allow the collar to slide away from the elastomeric sleevefor the insertion process in the body cavity of the patient.

In accordance with one important independent optional feature of theinvention, the peripheral engagement member is releasable from theinsert sleeve portion and the elastomeric sleeve portion by the manuallyoperable release member. Preferably the release member is movableaxially to release the peripheral engagement member, for example byrotation on a screw thread.

In accordance with one important independent optional feature of theinvention, an edge portion of the annular expandable member orelastomeric member is clamped between an inner insert sleeve portion andan outer peripheral engagement member to hold the edge portion clampedto the annular abutment collar.

In accordance with one important independent optional feature of theinvention, the releasable clamping member on the annular abutment collarcomprises a disk member having a central opening for surrounding thetrocar, the central opening having an edge portion spring biased in adirection axially toward the trocar for engaging the trocar, and thedisk member having a manually engageable portion exposed at one side ofthe annular abutment collar for pressing the disk member in a directionof the central opening axially away from the trocar against the springbias.

In the case where the expandable member is expanded by fluid, preferablythere is provided a tubular conduit which connects the source of fluidto the annular expandable member wrapped helically around the trocar.

BRIEF DESCRIPTION OF THE DRAWINGS

One embodiment of the invention will now be described in conjunctionwith the accompanying drawings in which:

FIG. 1 is an isometric view from the top and one side of a trocarsupport according to the present invention.

FIG. 2 is a first side elevational view of the embodiment of FIG. 1.

FIG. 3 is a second side elevational view of the embodiment of FIG. 1.

FIG. 4 is a third side elevational view of the embodiment of FIG. 1shown in an expanded position.

FIG. 5 is a first longitudinal cross-sectional view of the embodiment ofFIG. 1 showing the expandable member and the collar in a positionlatched together.

FIG. 6 is a second longitudinal cross-sectional view of the embodimentof FIG. 1.

FIG. 7 is an exploded view of the embodiment of FIG. 1.

FIG. 8 is a cross-sectional view along the lines 9-9 of FIG. 6.

In the drawings like characters of reference indicate correspondingparts in the different figures.

FIG. 9 is a longitudinal cross-sectional view of a second embodiment ofthe trocar support according to the present invention.

FIG. 10 is a longitudinal cross-sectional view of a third embodiment ofthe trocar support according to the present invention.

FIG. 11 is a longitudinal cross-sectional view of the embodiment of FIG.10.

FIG. 12 is an isometric view from the top and one side of a trocarsupport according to a fourth embodiment of the present invention in afirst position of the inflation system.

FIG. 12A is a view similar to that of FIG. 12 showing the inflationsystem in a final position of the inflation system.

FIG. 13 is an isometric view partly in cross-sectional of the embodimentof FIG. 12.

FIG. 14 is an exploded view of the embodiment of FIG. 12 showing theinternal components.

FIG. 15 is an isometric view of one part only of the embodiment of FIG.12 showing the arrangement for releasably clamping the slidable collarto the trocar.

FIG. 16 is an isometric view of one part only of the embodiment of FIG.12 showing the arrangement for releasably connecting the expandablecollar to the slidable collar.

FIG. 17 is an isometric view partly in cross-section similar to that ofFIG. 13 showing the inflation system in the final position.

FIG. 18 is a cross-sectional view along the lines 18-18 of theembodiment of FIG. 12 showing the inflation system in a partly inflatedposition.

FIG. 19 is a cross-sectional view similar to that of FIG. 18 showing afurther embodiment of the invention.

FIG. 20 is a top plan view of the embodiment of FIG. 19.

FIG. 21 is a side elevational view of the embodiment of FIG. 19.

DETAILED DESCRIPTION

In FIGS. 1 to 9 is provided a trocar support 10 for attachment to atrocar 12 to support a sleeve 11 of the trocar 12 while the sleeve 11penetrates through a body wall 13 of a patient as shown schematically inthe FIG. 4.

The support 10 comprises an abutment member 14 shaped to be received onan outer surface of the trocar sleeve. The abutment member forms acollar 14A surrounding the sleeve with a manually operable clamp 14B forreleasable connection to the sleeve 11 so as to be adjustablelongitudinally of the trocar sleeve 11 so as to be located at a selectedposition 11A as shown in FIG. 4.

The support 10 includes an inflatable collar 15 for mounting on thetrocar sleeve 11 at a required position 15B spaced from the abutmentmember 14 at the position 11A. The inflatable collar can be inflated bya source of fluid, typically air or other gas, from a pump 17 to apredetermined size through a supply tube 16.

As shown in FIG. 1, the inflatable collar while deflated can be insertedon the trocar sleeve through an incision in the body wall and can beinflated from the pump 17 through the tube 16 when inserted to theinflated condition shown in FIG. 4 at 15A to engage an inside surface ofthe body wall 13. The abutment member can be moved to a position 11A tohold the body wall 13 between the abutment member 14 and the inflatablecollar 15.

The source of fluid provided by the pump 17 is located on the trocarsupport and particularly the abutment member 14 so as to be carriedthereby.

The source of fluid therefore is a pump mechanism forming a part of thetrocar support and operable by hand. The source of fluid 17 provides afixed volume allowing inflation of the collar 15 only to a fixed size.

The tube 16 is of a circular cross-section or in some cases of aflattened cross-section so as to lie flat against the sleeve of thetrocar and is wrapped helically around the sleeve of the trocar. Thus itcan lie in compressed side by side turns as shown in the initialposition in FIG. 1 and can extend axially as shown in FIG. 4.

As shown in FIG. 1, the inflatable collar 15 and the abutment member 14form a common collar portion 10 which can be engaged onto the trocarsleeve 11 and moved axially therealong from the lower insertion end to arequired position along the length of the trocar sleeve. In order tohold the assembly rigid and intact for insertion onto the trocar, thereis provided a connection system 19.

The abutment member 14 can move axially along the trocar sleeve from theinflatable collar 15 when the latter has reached its required axiallocation 15B with the tube 16 being extended along the trocar sleeve asthe abutment member moves away from the inflatable collar.

As described hereinafter the connection system 19 includes a componentto hold the inflatable collar 15 against axial movement at the requiredlocation 15B on the trocar sleeve. This device can operate using manydifferent techniques as described below, so as to ensure that the collar15 remains at the required location until the inflation secures it moreeffectively.

Additional attention may be required in regard to some constructions toensure that the lower inflatable collar remains in place afterapplication of the device to the trocar and while the trocar is insertedinto an incision in the body wall of the patient.

This arrangement is more convenient for a surgeon to insert and removefrom the patient than the conventional arrangements of this type wherethe protrusions are actually a course thread and the trocar sleeve mustbe threaded into and out of the incision and fascia. The twisting actionwhile inserting or removing a conventional threaded trocar cantraumatize the fascia. The described arrangement is intended to beengaged within the fascia itself after it is inserted, thus avoidingpotential damage to the fascia from the twisting action.

Other conventional arrangements, use ribs so as to attempt to reduce thepossibility that the trocar is pulled from the incision. However thesearrangements are also ineffective in that ribs may hold the trocar moreeffectively but in the event that the ribs are pulled through theincision, further and more damaging trauma may occur to the incision.Also the incision stretches over time and so the ribs becomeineffective.

The arrangement of the present invention is therefore provided so as toform specific stop members on the inside and outside of the incision toprevent the trocar from migration. This arrangement where the device isseparate from the trocar and is applied onto the trocar prior to its useallows the device to be used with different forms of trocar anddifferent dimensions of trocar as a separate disposable item. Theability to adjust the positions of the inflatable collar on the trocarand also the slidable collar allows the surgeon to select thelongitudinal position of the trocar relative to the incision. Thepresent arrangement provides for the first time an effective separatesupport tool for use with different trocars.

In the present arrangement the inflation is effected by an inflatablemanual pump of the type previous described which is carried on a collarpart of the trocar itself. This controls the amount of fluid applied andobviates the need for separate fluid source.

The trocar support apparatus 10 is therefore used with the trocar 12where the apparatus 10 is a separate component from the trocar itselfenabling the apparatus to be disposable independently of the trocar sothe trocar may be a reusable item. The support apparatus acts tomaintain the trocar in the fixed position in the body wall of thepatient while the trocar extends through the body wall of the patient.

The apparatus therefore includes the expandable member 15 whichcomprises a body for surrounding the trocar including an inner wall 15Cand an outer wall 15D defining a chamber 15E therebetween. The innerwall 15C is arranged to closely surround the sleeve of the trocar in afriction fit so as to remain in place when installed at the requiredlocation 15B. The inflation of the fluid into the chamber 15E assist inmaintaining the inner wall 15C in the fixed position. This position caneither be directly at the end of the trocar sleeve or can be a selectedposition spaced along the trocar sleeve as chosen by the surgeondepending upon the intended position of the end 11B of the trocar.

The tube 16 which leads from the source of fluid to the inflatablemember is formed with a sealed connection into the chamber 15E andextends in the helical manner around the trocar to the source.

The annular abutment collar 14 is also arranged to be received on thetrocar and the required position and can be fixed in place by themanually operable button 14B. The button 14B acts as a releasableclamping member for engaging the sleeve or 11 at the required position.

The coupling arrangement 19 includes a connecting assembly defined by afirst piece 19A and the second piece 19B as best shown in FIGS. 5, 6 and8. These pieces act to hold the annular expandable member 15 as a commoncomponent with the annular abutment collar 14 for common insertion ofthe trocar through these components to the required position. The twopieces are releasable by a release component 19C to effect release ofthe annular expandable member 15 from the collar 14 so that whenreleased the collar 14 is longitudinally movable relative to theexpandable member 15 so that the collar can be moved to the requiredposition adjacent to the exterior of the body wall to squeeze the bodywall between the collar and the expandable member to hold the device andtherefore the trocar in place.

As best shown in FIGS. 2 and 3, the source of fluid connected to theupper end of the tube 16 comprises a disc-shaped bladder 20 surroundingthe trocar 11 and compressible between two operating discs 21 and 22.The disc 22 has the bladder 20 attached to the surface of the disc 22facing the disc 21 so as to be carried thereby. The disc 22 forms anintegral component with a collar or sleeve 23 which surrounds the trocar11. The disc 21 is carried in an upper collar 24 which can slide alongthe outer surface of the sleeve 23 in a sliding action in which the disc21 approaches the disc 22. Therefore sliding action of the disc 21downwardly toward the disc 22 causes the annular bladder 20 to becompressed to expel the full amount of fluid within the bladder. Thissliding action is carried out by a threaded arrangement formed by rampsurfaces 25, 26 on the collar 24 and on the rear surface of the disc 21.A spring 27 is located between the ramp surfaces 25 and 26 and acts tobias the discs 21 and 22 apart in to an expanded position of the bladder20. Movement of the discs 21 and 22 to a compressed position of thebladder 20 is carried out by a pair of levers 28 and 29 which aresqueezed together manually so as to rotate the collar 24 relative to thedisc 21 so that the ramp surfaces cause the longitudinal movement of thedisc 21 toward the disc 22.

Each of the levers 28, 29 includes a manually operable finger padallowing the finger and thumb of the user to squeeze the leverstogether. A latching arrangement schematically illustrated in FIG. 1 at30, 31 is provided to hold the finger pads together in a locked positionwhen the levers are moved to the squeezed up position expelling thefluid from the bladder 20. The latch 30, 31 is operated only when thelevers are fully squeezed so that if the levers do not reach the fullysqueezed position then that no latching occurs and the spring 27 acts toreturn the levers to the initial position thus re-filling the bladder 20and retracting the fluid from the expandable member 15. The devicetherefore requires that the user operate the levers only to the fullysqueezed position and prevents any possible situation where the member15 is only partly expanded. The latch 30, 31 is also arranged to releasein the situation where the finger pads are pushed together at a timeafter the latched expansion has been completed. Thus the user inoperation causes the expansion of the member 15 and releases the fingerpads in the latched position. At a later time when it is required todeflate the member 15 after the procedure is completed, a furthercompression of the finger pads causes the latch 30, 31 to be released sothe spring 27 causes the deflation of the member 15.

The discs 22 and 21 together with the bladder 20 have a central circularopening 32 for passage of the trocar 11.

The coupling arrangement 19 is best shown in FIGS. 5, 6 and 7. Thisincludes the component 19A which has a collar 19D and a sleeve 19E. Thesleeve 19E is tapered at an end 19F so as to form an end portion whichcan be inserted into a frustoconical section 15G of the inflatablemember 15. The section 15G is located at the end of the member 15adjacent the sleeve 19E and its end portion 19F so that the end portion19F holds the section 15G open for passage of the trocar through thechannel 32 and through the sleeve 19E into the member 15. In this waythe upper end of the member 15 is prevented from being pushed downwardlyby the end 11B of the trocar. The section 15G of the inflatable memberis maintained in a frustoconical position by the tapered section 19F andreverts to a cylindrical position surrounding the trocar when the second19F is removed due to the elastic nature of the inflatable member.

In order to prevent the frictional engagement between the outsidesurface of the trocar on the inside surface of the member 15 fromtending to push the member 15 downwardly before its selected position,the member 19B is used to pinch the outside surface of the portion 15Gonto the tapered end 19F, In order to do this, the member 19B includes aplurality of fingers 19G with end tips which engage the outside surfaceof the portion 19F when the fingers 19G are squeezed together. Ininitial assembly of the construction, the fingers 19G are squeezedtogether by the coupling 19C on the collar 14. However rotation of thecoupling 19C causes a threaded ramp 19H to move the coupling 19C axiallyalong the fingers 19G so as to allow the fingers to move outwardly awayfrom the portion 15G. This operation can be seen best by comparing FIGS.5 and 6 where in FIG. 5 the fingers 19G are compressed inwardly tosqueeze against the portion 15G. In FIG. 6 the coupling 19C has movedaxially allowing the spring in the fingers 19G to cause the fingers tomove outwardly away from the portion 15G. In this way the portion 15G isheld pinched during the insertion of the trocar through the device andthen it is released at the required position selected by the user byrotating the collar 14 and the coupling 19C so that the portion 15G isallowed to slide off the tapered end 19F. The frictional contact betweenthe inside surface of the member 15 and the trocar allows the member 15to be pulled off the device and placed onto the trocar while theremaining part of the device, move axially away from the member 15. Thismovement causes the tube 16 to expand along the length of the trocar sothat it extends from the inflatable member 15 to the expansion bladder20.

As shown in FIGS. 6, 9 and 8, the annular abutment member 14 surroundsthe opening 32 to allow the passage of the trocar. A manually releasableclamping member 14B is provided on the abutment member 14 for clampingonto the outside surface of the trocar. The clamping member 14Bcomprises a flat disk with a central opening 14R which surrounds thetrocar. One side edge 14S of the opening 14R pinches against the outsidesurface of the trocar as shown in FIG. 6. However pressure against anend portion or button 14T of the member 14B acts to push the disc sothat the edge 14S is moved away from the outside surface of the trocar.The opening 14R is thus non-circular so that when depressed by thebutton 14T is moved away from the trocar. A spring arrangement 14X isprovided at the back of the disc opposite the button 14T so as to pushthe disc into engagement between the edge 14S and the trocar except whenthe button 14T is depressed.

The arrangement here and therefore provides a single unit where theinflatable member 15 and the annular collar 14 are connected togetherduring the insertion of the trocar. The connection between them isdivided by the components themselves rather than any additionalremovable components. Simple rotation of the collar 14 allows theseparation of the collar from the inflatable member to occur at arequired position of the inflatable member selected by the user. Whenthe inflatable member is in position on the trocar, the collar can bemoved away from the inflatable member sufficiently for the user toinsert the trocar through the body wall of the patient so that theinflatable member is located inside the body wall allowing it to beinflated by compression of the bladder 20 through the tube 16, followingwhich the collar 14 is moved up to a position outside the body wall ofthe patient to effect squeezing of the body wall sufficient to hold thetrocar in place. Release of the inflation of the body after theoperation is complete is carried out by releasing the latch 30, 31 whichcauses the inflatable member to deflate allowing the trocar to be simplypulled from the incision.

In FIG. 9 is shown an alternative arrangement which uses the sameinflation system as described above for supplying fluid to theinflatable member 151. In this arrangement an alternative constructionis provided for attaching the inflatable member 151 to the collar 141.In this arrangement the inflatable member 151 includes an upper portiongenerally indicated at 152 which extend upwardly beyond the inflatableportion indicated at 153. The upper portion 152 is all increasedthickness and tapers downwardly at 154 to form the inner surface of theinflatable balloon 153. Above the tapered portion 154 is provided asleeve 153 which extend upwardly and that is then shaped to form acollar portion 155 with a recess 156 surrounding the collar portion. Aclamping ring 157 engages into the recess 156 to hold the collar portion155 within a recess 142 of the collar 141. The clamping ring 157 isreleasable by any suitable mechanical method such as sliding or rotationto move away from the recess 156 to release the inflatable member 151from its clamp position in engagement with the collar 141. The deviceoperates therefore in the same manner as described in that theinflatable member is held clamped to the collar 141 while the trocar isinserted through the collar 141 and through the portion 152 of theinflatable member 151 until the inflatable member 153 reaches therequired position. At this point the member 157 is operated to releasethe inflatable member and to allow the collar 141 to be moved away.

Turning now to FIGS. 10 and 11, there is shown a further arrangementwhich uses the same components as described above in relation to FIG. 6including the fingers 19G. However in this embodiment instead of merelypinching the top edge of the balloon or inflatable member between thefingers on the conical section 19F, the fingers 19G cooperate with abottom shoulder 163 of an inner wall 164 of the inflatable member 161.This inflation fluid is injected in this inflatable member 161 betweenthe inner wall 163 and the outer inflatable portion 162 to effect theinflation when required. However the thickness of the inflatable memberat the inner wall is sufficient to define the shoulder 163 which can besuitably grasped by the fingers 19G to hold the inflatable member 161within the interior of the collar 14.

Thus in both of the embodiments of FIGS. 9, 10 and 11, inflatable memberis of a more complex and thicker construction which may bedisadvantageous in that the thicker wall must pass through the incision,but this thicker construction allows a more effective clamping action ofthe component of the collar 14 on to the inflatable member 15 to hold itbetter in place. In addition this arrangement may reduce the overalllength of the system so as to avoid taking up excessive amount of thelength of the shaft of the trocar which could interfere with theinsertion into the incision.

Turning now to the embodiment of FIGS. 12 to 16, there is shown a trocarsupport apparatus 201 for use with a trocar T separate from theapparatus. The apparatus comprises an annular expandable member 203 forextending around the trocar which includes a balloon portion 204expandable in an inflation movement from a collapsed condition radiallyoutwardly of the trocar to a predetermined size for engaging theinterior of the body of the patient as previously described.

The apparatus further includes an annular abutment collar 202 arrangedto be received on the trocar at a required position thereon which isadjustable longitudinally of the trocar so as to be located at aselected position on the trocar to allow the insertion into the incisionand then to clamp against the outside of the body as previouslydescribed.

The slidable collar 202 comprises a generally cylindrical body formingfour sections 205 to 208 arranged in a row and coaxial around a hollowcore through which the trocar passes.

The slidable collar 202 includes a releasable clamping member as section207 of the annular abutment collar for locating the annular abutmentcollar on the trocar at the selected position when adjusted.

As described above, the expandable collar 203 is arranged while in itscollapsed condition as shown to be inserted through an incision in thebody wall and then expanded when inserted to engage an inside surface ofthe body wall.

The annular expandable collar is inflatable by a manually operabledevice providing a source of air in the form of a pump defined bysections 205 and 206 mounted on the slidable collar 202. In particularthe annular sections 205 and 206, which surround a central opening 209for passage therethrough of the trocar, define a fluid containingchamber 210 therebetween. The sections 205 and 206 each carry abutments212 and 213 of a manually operable compression device for squeezing thesection 205 in an axial direction toward of the other section 206 forexpelling fluid from the fluid containing chamber 210 through a helicalduct 215 as previously described to the expandable collar 204.

The section 206 forms an annular cylinder 227 having a cylindricalexterior wall 214 and a closed bottom wall 216 into which the duct 215connects. The cylinder further includes an inner wall 217 with both theinner wall 217 and the outer wall 214 terminating at upper edges 218,219.

The section 205 carries an internal annular piston 220 with a base 221,an outer wall 222 and an inner wall 223. The walls 222 and 223 each havean external channel 225 carrying sealing rings 226 for sliding movementon the inside surfaces of the cylinder. The piston 220 and the cylinder227 define therebetween the chamber 210 in the cylinder so that themovement in the axial direction causes the chamber 210 to be reduced involume expelling the fluid therefrom through the duct 215. The channelsand sealing rings can be replaced by a wiper seal arrangement (notshown) integrated into the outer wall of the piston.

The outer wall 214 of the cylinder carries a shallow screw thread 228which connects with a cooperating recess 229 in a sleeve portion 230 ofthe section 205. Thus the section 205 includes an upper cap 231 and thedepending sleeve 230 surrounding the outer wall of the cylinder definedby the section 206. The screw thread thus acts for interconnecting theannular members defined by the sections 205 and 206 so that rotation ofone around the axis causes relative axial movement to force the pistoninto the cylinder.

The screw thread is arranged so that the cylinder 227 and the piston 220can be moved to a position in which the seal 226 is moved to a positionallowing entry of a sterilizing fluid material from the exterior toenable the chamber 210 to be properly sterilized. The device can thususe conventional sterilizing systems to pass cleaning fluid through thewhole system including the chamber. Once the seals enter the cylinder, afixed volume of air is defined in the chamber 210 which is then expelledas the section 205 is moved downwardly to provide that fixed volume tothe inflatable collar to ensure inflation to a predetermined size.

The piston 220 on the section 205 is driven forwardly relative to thecylinder on the section 206 by squeezing together the two abutments 212and 213 projecting radially outwardly from an exterior of each of theannular members. The piston itself does not rotate as it is heldstationary relative to the cylinder as the outer cap 231 rotates andthere is a bearing between these components. The abutments start at anangle of the order of 40 degrees and are moved together in the squeezingaction until they are at or close to touching. The position shown, whichis roughly at 120 degrees, shows the position in which the section 205is moved to a release positon for the sterilizing fluid to enter thecylinder around the head of the piston, A latch finger 232 is attachedto the abutment 212 and extends inside the abutment 213 (FIG. 12A) andincludes a latch head 233 which snaps behind the abutment 213 to holdthe abutments in the closed position until the user releases the latchhead from the latching position.

A coiled torsion spring 234 is wrapped around the center core 209 andlocated between the annular members is attached at one end 235 to thesection 205 and at the other end 236 to the section 206. The spring istightened as the section 205 is rotated to the latched position andacts, when the latch is released, to rotate the sections in a returndirection to a retracted position shown in FIG. 12 to deflate theexpandable member by withdrawing the same fixed volume of fluid into thechamber 210.

Section 207 is shown in FIG. 15 which provides an arrangement where theannular abutment collar 202 is clamped to the trocar T by a clampmechanism in the form of a disk member 240 having a manually engageableportion 241 exposed at one side of the annular abutment collar 202 forpressing the disk member 240 in a direction radially away from thetrocar against a spring bias. The clamp mechanism 240 is designed sothat the collar 202 is clamped to the trocar T until pressure is appliedto the release button 241. While the button 241 is in the depressedstate, the collar is free to slide along the axis of the trocar. Thisdrawing depicts the mechanism with the button in the partially depressedposition.

In the arrangement shown, a metal spring 243 applies a constant force tothe button 241 in the direction outwardly from the trocar, in whichposition the trocar is clamped. The button 241 extends into the interiorof the section 207 and includes a generally rectangular tray portion 247containing a resilient hinged clamp 244. The force from the spring 243on the button 241 causes the resilient hinged clamp 244 to interferewith the wedge-shaped profiles 245 and 277 in the interior opening 252of the tray portion 247 of the button 241. The cooperation between theprofile 277 and an outer edge 248 of the clamp 240 results incompression of the clamp 240 around the circumference of the trocar. Thegaps to 249 and 250 at either end of the clamp 240 close together whileclamping around the trocar.

When the user applies sufficient thumb pressure to the button 241 toover-come the force of spring 243, the button 241 will engage the clamp240 at point 251 causing the hinged clamp 240 to open-up and release itsgrip around the trocar.

The profile of the opening 252 in the tray portion 247 of the button 241widens allowing the wedges 248 to move apart relative to the clampedposition allowing the clamp space to open-up.

Releasing the thumb pressure from button 241 will cause the slidablecollar 240 to clamp onto the trocar again. The semi-cylinders 253 aroundthe clamp-trocar interface allow ethylene oxide (ETO) gas to passthrough during the sterilization process.

The clamp 240 is formed in a plurality of individually hinged sectionssurrounding a resilient ring 254 formed of flexible silicone rubber. Aninside surface 255 of the ring 254 engages frictionally around theoutside surface of the trocar. The individual sections of the clampensure that a substantially constant pressure is applied onto theoutside surface of the trocar so as to provide an effective clampingaction. This avoids the situation where the clamping force is restrictedto a certain part or parts of the periphery of the trocar which can leadto an unacceptable clamping force.

The tray 247 is mounted in the annular body defining the section 207which is molded with the guide walls 256 which guide the sliding actionof the button 241 when depressed. The abutment 213 which is part of thepumping mechanism is mounted on the outside surface of the section 207and this section is fixed and held stationary relative to the trocar bythe clamping action and the by its cooperation with the section 208 towhich it is attached by fasteners. As shown in FIG. 18, the tray 247sits on a bottom wall 257 of the section 207 and is prevented fromlifting upwardly from the section 207 by its engagement with theunderside of the bottom wall 216 of the section 206. The spring 243includes an arch portion 258 extending around the outer wall 259 of thesection 207 together with end tab portions 260 which butt against theend wall of the tray 247. This pushes against the tray, extending thebutton 241 and pressing the wedges 245 and 277 against the surface 248of the clamp 240 acting to squeeze it around the ring 254 in theclamping action.

As shown in FIGS. 16 and 18 is provided a connecting component 262mounted on the annular abutment collar at the section 208 for engaging aportion of the annular expandable member to engage and hold the annularexpandable member in engagement with the annular abutment collar. Thesection 208 comprises a base wall 261 and an upstanding peripheral wall263 generally matching in diameter the outside surface of the section207. On the base wall 261 is provided a plurality of annular fixingcollars 264 by which the components are clamped together by suitablefasteners. The component 262 acts to clamp together the expandablecollar portion and the abutment portion for common insertion of thetrocar therethrough. The component 262 comprises a collar 265 whichsurrounds an upper part 266 of the expandable balloon 204. On the top ofthe upper part 266 is provided an outer band 267 defining a bottomshoulder 268 which sits on the top of the collar 265. An internalopening 269 has a large section 270 on the smaller section 271 where thesmaller section clamped closely around the upper part 266 under the band267. When the component 262 is pivoted around a mounting member 272,this causes the larger section 270 to move to a position around theupper portion 266 so that this portion is released from the clampingaction allowing the abutment member and the expandable member to moveapart.

In some embodiments, the annular expandable member 204 includes a sleeveslightly bigger than the trocar with an internal peripheral rib 305 onthe inside surface of the upper portion 266 at the band 267 whichengages over a rib on the trocar to lock the annular expandable memberin place. In other embodiments such as shown in FIGS. 1 to 11, thesleeve of the expandable member is arranged to be tight on the trocarand is held spaced from the trocar by the insert portion from thecollar.

In this way the component 262 includes a release member defined by alever 273 to release the clamping action to allow movement of theexpandable member after the expandable member is moved to a requiredposition of the annular expandable member on the trocar. The releasemember defined by the lever 273 slidable in a slot 274 in the wall 263is operable to release the connecting component 262 to effect release ofthe annular expandable member from the annular abutment collar. Whenreleased the annular abutment collar is movable longitudinally relativeto the annular expandable member such that the annular abutment collaris moved to a position to hold the body wall between the annularabutment collar and the annular expandable member.

The connecting component 262 and the release member 273 are carried onthe annular abutment collar 202 at the section 208 and the connectingcomponent 262 includes a surface 271 for engaging a component 266 of theannular expandable member.

In the arrangement shown the component 262 is mounted for pivotalmovement around a mounting pin, however the component can form a diskwhich slides in and out of the section 208 is a radial direction so thatthe keyhole shaped slot 270, 271 moves relative to the trocar and theupper portion 266 of the expandable member.

A projecting member 275 on the on the underside of the arm 273cooperates with a slot 276 in the base wall 261 so as to guide andlocate the arm in its movement between the two positions defined above.Suitable restrictions can be provided in the slot 276 to actively locatethe arm and its two positions.

The keyhole shaped surface 269 of the connecting component surrounds thetrocar so that a portion 266 of the annular expandable member projectsaxially into the interior of the surface to hold the expandable memberin place. The surface 269 of the sliding plate 265 forms a ring on thesection 208 of the collar 202 defining an opening in the plate or disk265 to hold and release the portion 266.

In another arrangement shown in FIGS. 19 to 21 the pump defined above bythe cylinder and the cooperating piston is replaced by a simple bellowsarrangement 300 located between the abutments 212 and 213. In this way,as the abutments 212 and 213 are squeezed together manually, this actsto compress the bellows arrangement 300 which forces air from theinterior of the bellows arrangement in to the duct 215. A spring 301 isprovided which can be either as the same construction as described aboveforming a helical coil around the trocar or it can be a simplecompression spring 301 located at the bellows and is compressed as thebellows is depressed. This arrangement is a more simple constructionavoiding the necessity for the interior components defining the cylinderand the piston walls. As described above it is essential that theinterior of any pumping arrangement such as the bellows can be accessedby exterior fluid for a sterilizing action. A valve arrangement 303 isprovided which allows entry of the fluid into the bellows, which is thenclosed during the operation of the bellows. This can be closed by amanually operable member 302 or automatically by a component of thesystem. In both cases the valve is arranged as a onetime operationdevice which acts to close off the access to the exterior sterilizingfluid and to connect the bellows to the conduit 215. As described abovethe bellows when closed provides a fixed volume of air which is pumpedfrom the bellows through the duct into the inflation balloon to ensureinflation to a required level.

1. A trocar support apparatus for use with a trocar separate from theapparatus for maintaining the trocar in fixed position in a body wall ofa patient while the trocar extends through the body wall of a patient,the support comprising: an annular expandable member for extendingaround the trocar, said annular expandable member being movable in anexpansion movement from a collapsed condition radially outwardly of thetrocar to a predetermined size; an annular abutment collar arranged tobe received on the trocar at a required position thereon; the annularabutment collar being adjustable longitudinally of the trocar so as tobe located at a selected position; a releasable clamping member on theannular abutment collar for locating the annular abutment collar on thetrocar at the selected position; said annular expandable member beingarranged while in said collapsed condition to be inserted through anincision in the body wall and expanded when inserted to engage an insidesurface of the body wall; wherein the annular expandable member isexpandable by a manually operable device providing a source of the fluidmounted on the annular abutment collar; wherein the manually operabledevice comprises a pair of annular members locating a fluid containingmember therebetween, the annular members and the fluid containing membersurrounding a central opening for passage therethrough of the trocar;and a manually operable compression device for squeezing one of theannular members in an axial direction toward of the other annular memberfor expelling fluid from the fluid containing member.
 2. The trocarsupport apparatus according to claim 1 wherein one of the annularmembers comprises a cylinder and the other of the annular memberscomprises a piston defining a chamber in the cylinder so that themovement in the axial direction causes the chamber to be reduced involume expelling the fluid therefrom.
 3. The trocar support apparatusaccording to claim 1 wherein the fluid containing member can be arrangedto enable the entry of sterilizing fluid.
 4. The trocar supportapparatus according to claim 1 wherein the manually operable compressiondevice comprises a screw thread interconnecting the annular members sothat rotation of one around the axis causes said relative axialmovement.
 5. The trocar support apparatus according to claim 4 whereinthe screw thread is on an outside surface of one of the annular members.6. The trocar support apparatus according to claim 1 wherein themanually operable compression device includes a latch for holding theannular members in fixed position after a volume of fluid is supplied.7. The trocar support apparatus according to claim 1 wherein the annularmembers are moved by squeezing together two abutments projecting from anexterior of each of the annular members where at least one of theabutments is rotatable around the axis.
 8. The trocar support apparatusaccording to claim 1 wherein there is provided a spring which rotatesthe annular members in a return direction to a retracted position todeflate the expandable member.
 9. The trocar support apparatus accordingto claim 8 wherein the spring is located between the annular members.10. The trocar support apparatus according to claim 8 wherein the springis wound around the trocar.
 11. The trocar support apparatus accordingto claim 1 wherein there is provided a connecting component mounted onthe annular abutment collar for engaging a portion of the annularexpandable member to engage and hold the annular expandable member inengagement with the annular abutment collar and a release memberoperable to release the connecting component to effect release of theannular expandable member from the annular abutment collar.
 12. Thetrocar support apparatus according to claim 11 wherein the connectingcomponent and the release member are carried on the annular abutmentcollar and the connecting component includes a surface for engaging acomponent of the annular expandable member.
 13. The trocar supportapparatus according to claim 12 wherein the surface of the connectingcomponent surrounds the trocar so that a portion of the annularexpandable member projects axially into the interior of the surface. 14.The trocar support apparatus according to claim 13 wherein theconnecting component comprises a ring on the annular expandable memberwhich is held by a sliding plate on the annular abutment collar with anopening in the plate to hold and release the ring.
 15. The trocarsupport apparatus according to claim 1 wherein the annular expandablemember comprises an elastomeric sleeve portion having an inner surfacearranged to engage onto the trocar and wherein there is provided aninsert sleeve portion on the annular abutment collar engageable into ahollow interior of the elastomeric sleeve portion for engaging the innersurface and the holding the inner surface open for passage of thetrocar.
 16. The trocar support apparatus according to claim 15 whereinthe insert sleeve portion is tapered so as to hold the elastomericsleeve portion in a frustoconical portion at the end edge of theelastomeric sleeve portion.
 17. The trocar support apparatus accordingto claim 1 wherein the annular abutment collar is clamped to the trocarby a disk member having an inner surface surrounding the trocar and amanually engageable portion exposed at one side of the annular abutmentcollar for retracting the disk member in a direction radially away fromthe trocar against a spring bias.
 18. The trocar support apparatusaccording to claim 17 wherein the disk member surrounds the trocar andincludes components applying a force to the trocar at all pointstherearound.
 19. A trocar support apparatus for use with a trocarseparate from the apparatus for maintaining the trocar in fixed positionin a body wall of a patient while the trocar extends through the bodywall of a patient, the support comprising: an annular expandable memberfor extending around the trocar, said annular expandable member beingmovable in an expansion movement from a collapsed condition radiallyoutwardly of the trocar to a predetermined size; an annular abutmentcollar arranged to be received on the trocar at a required positionthereon; the annular abutment collar being adjustable longitudinally ofthe trocar so as to be located at a selected position; a releasableclamping member on the annular abutment collar for locating the annularabutment collar on the trocar at the selected position; said annularexpandable member being arranged while in said collapsed condition to beinserted through an incision in the body wall and expanded when insertedto engage an inside surface of the body wall; wherein the manuallyoperable device comprises a pair of members locating an inflation fluidcontaining member therebetween; and a manually operable compressiondevice for squeezing one member toward the other member for expellingthe inflation fluid from the fluid containing member; wherein the fluidcontaining member can be opened to enable the entry of sterilizing fluidand closed to effect the expulsion of the inflation fluid.
 20. Thetrocar support apparatus according to claim 19 wherein the fluidcontaining member is opened by a valve.
 21. The trocar support apparatusaccording to claim 19 wherein the fluid containing member is movable toa position where a chamber defined therebetween is opened to allow theentry of the sterilization fluid and then is closed to enclose a volumeof the inflation fluid.
 22. A trocar support apparatus for use with atrocar separate from the apparatus for maintaining the trocar in fixedposition in a body wall of a patient while the trocar extends throughthe body wall of a patient, the support comprising: an annularexpandable member for extending around the trocar, said annularexpandable member being movable in an expansion movement from acollapsed condition radially outwardly of the trocar to a predeterminedsize; an annular abutment collar arranged to be received on the trocarat a required position thereon; the annular abutment collar beingadjustable longitudinally of the trocar so as to be located at aselected position; a releasable clamping member on the annular abutmentcollar for locating the annular abutment collar on the trocar at theselected position; said annular expandable member being arranged whilein said collapsed condition to be inserted through an incision in thebody wall and expanded when inserted to engage an inside surface of thebody wall; wherein the manually operable device comprises a pair ofmembers locating an inflation fluid containing member therebetween; themembers including a manually engageable projection extending generallyradially outwardly from the annular abutment collar; and a manuallyoperable compression device for rotating one member around the axis ofthe trocar toward of the other member for expelling the inflation fluidfrom the fluid containing member.